Tissue factor expression and multidrug resistance in cancer: two aspects of a common cellular response to a hostile milieu

Tissue factor (TF) is the main physiological initiator of blood coagulation and its activation or de-encryption within plasma membranes is important for trapping, extravasation and angiogenesis in the development and spread of solid malignancies. Multidrug resistance is also an adaptive response in malignant (and normal) cells. It is often mediated by the over-expression of the P-glycoprotein (P-gP) efflux pump. Both TF and P-gP tend to be expressed together, perhaps as part of a coherent 'crisis management' response of cells to environmental change or challenge. An associated feature in such a response appears to be the reversal of normal phospholipid charge asymmetry in the plasma membrane bilayer. Responses to environmental stimuli affect function in normal and malignant tissue. Uniting the study of TF expression or de-encryption and MDR-1 phenotype would be biologically enlightening and might ultimately influence clinical cancer management and the control of thrombotic problems associated with treatment. (C) 2000 Harcourt Publishers Ltd.